Assessing and Addressing Implicit Organizational Bias to Tackle Mental Health Disparities

项目总结/摘要 在美国，少数民族之间的心理健康差距已经达到了危机的程度。虽然 少数民族更容易患上抑郁症等精神疾病， 健康的决定因素，如贫困和歧视，他们不太可能寻求帮助，有机会，或 获得优质的心理健康服务。纠正这种差距和改善参与的努力往往 专注于增加新的服务或改变供应商的特点，包括他们可能会隐含的偏见， 不知不觉中，然而，最近的科学评论表明，文化和结构性障碍 嵌入在潜在的心理健康组织本身是一个重要的因素，在持续的持久性 心理健康的差异。虽然实施科学已经提高了我们对这种关系的认识， 在组织因素和采用循证实践之间， 组织问题的实证研究，因为它们涉及到心理健康的差距。这种研究上的差距 部分原因可能是在组织一级相对缺乏可操作的差异结构。 根据我们的研究，我们已经概念化了一个关键的组织机制，我们 术语隐式组织偏见（IOB）-或者，潜规则，信念，以及对 客户理想的行为方式和/或与心理健康系统互动以获得最佳利益 从可用服务（例如，客户应该是口头的，公开承认问题，接受服务，积极主动， 以个人为导向）。这些偏好的组织规范可能与少数民族的规范发生冲突 患者，导致不一致、次优或受损护理的可能性更高。提议的职业 发展奖旨在扩大实质性证据的内隐偏见超越其对个人的关注， 通过两个阶段的参与性，混合方法的研究，目的是：1） 系统地操作，并开发一种工具来评估，隐性组织偏见及其 与少数民族社区文化的一致性;和2）检查心理测量 IOB的性质测量和测试我们的概念模型中概述的关联途径。 虽然我在患者和社区层面的心理健康差异研究方面有丰富的经验，但这 K旨在发展我的技能：1）内隐偏见研究，组织理论和实施 科学; 2）概念绘图和评估开发，以及3）先进的混合方法和定量 research.我已经建立了一个全面的指导和培训计划， 国际领导人的差距，隐含的偏见，和组织研究。我的导师们， 耶鲁大学世界一流的培训环境将引导我实现成为一名独立的 心理健康差异的多层次影响的调查员，具有设计和实施方面的专业知识 严谨，务实的研究，旨在改善少数民族的参与，护理和临床结果。

PROJECT SUMMARY/ABSTRACT Mental health disparities among ethnic minorities have reached crisis proportions in the United States. Although ethnic minorities are more likely to experience mental illnesses such as depression and associated social determinants of health like poverty and discrimination, they are less likely to seek help from, have access to, or receive quality mental health services. Efforts to redress such disparities and improve engagement have often focused on adding new services or altering provider characteristics, including the implicit biases they may unknowingly hold. However, recent scientific reviews suggest that cultural and structural barriers deeply embedded in the underlying mental health organization itself are a significant factor in the continued persistence of mental health disparities. While implementation science has advanced our knowledge of the relationship between organizational factors and the uptake of evidence-based practices, there has been comparatively little empirical research on organizational issues as they pertain to mental health disparities. This gap in research may be due, in part, to the relative lack of operationalized constructs of disparity at the organizational level. Based on our research, we have conceptualized a key organizational mechanism of disparities—which we term Implicit Organizational Bias (IOB)—or, the unspoken norms, beliefs, and expectations about the way clients should ideally behave and/or interact with the mental health system to gain optimal benefit from available services (e.g., a client should be verbal, openly admit a problem, accept services, be proactive, be individually-oriented). These preferred organizational norms may conflict with the norms of ethnic minority patients, leading to a higher likelihood of incongruent, suboptimal, or compromised care. The proposed career development award seeks to extend the substantial evidence on implicit bias beyond its focus on individuals to the level of the organization through two phases of participatory, mixed methods research that aim: 1) To systematically operationalize, and develop a tool to assess, Implicit Organizational Bias and its congruence with the culture of ethnic minority communities; and 2) To examine the psychometric properties of the IOB measure and test the pathways of association outlined in our conceptual model. While I have extensive experience in mental health disparities research at the patient and community levels, this K is intended to develop my skillset in: 1) implicit bias research, organizational theory, and implementation science; 2) concept mapping and assessment development, and 3) advanced mixed methods and quantitative research. I have established a comprehensive mentoring and training program involving national and international leaders in disparities, implicit bias, and organizational research. My mentors, in combination with a world-class training environment at Yale University, will guide me towards my goal of becoming an independent investigator of multi-level influences on mental health disparities, with expertise in designing and conducting rigorous, pragmatic research aimed at improving engagement, care, and clinical outcomes for ethnic minorities.